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The Milbank Memorial Fund is an endowed operating foundation that aims to improve population health by connecting leaders and decision makers with the best available evidence and experience. It does this work by:
The Milbank Memorial Fund is an endowed operating foundation that publishes The Milbank Quarterly, commissions projects, and convenes state health policy decision makers on issues they identify as important to population health.
August 19, 2020
Multipayer Primary Care Network Primary Care Transformation Population Health COVID-19
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Pandemic response planning has largely been focused on hospitals, personal protective equipment, testing, and contact tracing. But the more we learn about the complex nature of COVID-19 disease, the more it is clear that a successful response also requires a well-funded and robust primary care system. More advanced primary care practice methods will be needed to meet the increasing clinical and social needs of community populations. This is the moment for payers and policymakers to invest in collectively strengthening primary care and community health organizations to create the community-responsive care system needed over the long term.
From day one of the pandemic, COVID-19–related calls have inundated primary care clinics. Care teams mobilized to keep up-to-date with constantly changing clinical recommendations, and helped keep mildly sick patients at home in order to preserve hospital capacity. Clinics also flexed systems to provide coronavirus-safe usual care, including virtual visits, hot lines, and new “respiratory clinics” that were stood up overnight, often in parking lots.
Primary care investment is moving beyond special ad hoc funding arrangements to keep vulnerable practices afloat in the face of decreased revenue due to stay-at-home and distancing precautions. Payers thus have the opportunity to implement COVID- and community-responsive advanced financing mechanisms. These new payment innovation models should incentivize the following:
Clarity around the crucial role of community-responsive primary care in addressing COVID-19 can promote a more coordinated and effective national pandemic strategy. It can also inform the next generation of overdue primary care financing. Primary care has always lived at the crossroads of physical, behavioral, and community health. Payers have a unique opportunity to strengthen those intersections to improve our nation’s health and reduce health care costs both in response to the current crisis and over the long term.
David Labby, MD, PhD, is health strategy adviser to Health Share of Oregon, the state’s largest Medicaid coordinated care organization (CCO), where he was the founding chief medical officer.
Jennifer DeVoe, MD, DPhil, is a practicing family physician and health services researcher based in Portland, Oregon and the chair of the Oregon Health & Science University (OHSU) Department of Family Medicine.
Andrew Morris-Singer, MD, is a board-certified internist and the founder and chair of Primary Care Progress, as well as co-director of the Morris-Singer Foundation.
Cat Livingston, MD, MPH, is a family physician and preventive medicine physician with expertise in evidence-based policy and an associate professor at Oregon Health & Science University.
1Personal email communication of Larry A. Green Center Quick COVID-19 Survey 6/30/2020.
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An endowed operating foundation that engages in nonpartisan analysis, collaboration, and communication, with an emphasis on state health policy.